The Lab is where it's at

In many places in the rural United States health care is a real issue because people don't have access to good clinics or hospitals.

And at the heart of every hospital is the laboratory where body fluids and tissues are examined, analyzed and tested.

"What happens to the blood sample you give at the doctor's office?" asks Dr. Leo Hardy, who is one of the doctors in charge of the lab services at Castleview Hospital. "How do doctors actually diagnose and confirm the presence of diseases? How do they monitor disease status or effectiveness of therapy? Why do patients need biopsies? These are all questions people ask when they come into the hospital.

One of the most critical components of human medical diagnostics are laboratory tests performed on blood, tissue, urine and/or body fluid. Although very few people realize it, an estimated 60 to 70 percent of all medical decisions regarding a patient's diagnosis, treatment, health care, hospital admission, and/or discharge are based on laboratory test results. No other area in medicine commands such a major role.

Yet, most patients don't know much more about it than the occasional unpleasant venipuncture (blood collection) or urine sample they left at their doctor's office or the hospital laboratory. That simply stated, is just the beginning of a very complex analytic process that begins with properly labeled specimen tubes, analysis with high tech automated chemistry and hemotology machines by specially trained, licensed and credentialed laboratory professionals.

Once processed, those complex results have to be provided to the doctor's office, emergency room, nursery or intensive care unit in a meaningful, confidential and often very fast or "stat" basis within minutes.

The world of laboratory medicine is dynamic and challenging. It's a place where laboratory professionals find answers to health questions. In the hospital laboratory a highly-skilled team of medical pathologists, medical technologists, medical laboratory technicians, phlebotomists, histologists, microbiologists, chemists, lab technicians and other specially trained specialists work together to determine the presence, extent or absence of disease and also provide valuable data needed to evaluate the effectiveness of medical treatment.

The fact is, the practice of modern medicine in Carbon and Emery counties, or anywhere for that matter, would be impossible without the tests performed in Castleview's laboratory.

Though most laboratory workers spend much less time in direct contact with patients than do doctors and nurses, medical laboratory professionals spend a lot more time working on the specimens from those patients. It is a 24/7 job.

"One might say, they are behind-the-scenes-medical-heros, or at least they are to me," states Dr. Hardy. "A night shift tech might have two patients in the emergency room, a premature infant in the nursery, and a patient in the ICU having a heart attack all at the same time."

Medical laboratory professionals provide laboratory testing services, not just for doctors office patients, hospital outpatients and inpatients, but also to those in distant medical clinics, nursing homes, public health facilities, health fairs, schools, nurseries and many different workplaces in the community.

In the future, major areas of scientific development and implementation in laboratory medicine will involve the immune system, blood and tumor cell marker technology, bioengineering, DNA technology, cytogenetics, medical informatics, molecular diagnostics and cancer research.

Although many patients might believe that a CT scan or x-ray is all that is needed to make a diagnosis, and generally such studies do suggest a preliminary list of differential diagnostic possibilities for a patient's illness. However, only with a tissue biopsy, blood draw, or collection of a body fluid will a patient's disease actually be proven and confirmed so that therapy can be correctly implemented.

A laboratory pathologist is a medical doctor who has completed the four years of undergraduate college education, four years of medical school but who has also completed a five year medical (pathology) residency. Historically and today, pathologists are often selected from the high achievers in medical school training programs, many also complete combined MD and PhD training.

Pathologists, on a daily basis, grossly (with the naked eye) and microscopically (with a microscope) examine tissues, cells, and body fluids and are responsible for the accuracy of all hospital laboratory tests. In fact, pathologists have traditionally always been one of the most important quality assurance team members in a hospital. Pathologists interpret, review and correlate the results of all patient diagnostic tests and studies- information that is important for the patient's correct diagnosis and ultimate recovery.

The pathologist and the patient's other doctors consult on which tests to order, the test results, and appropriate treatments. Pathologists play a vital role in ensuring diagnostic accuracy in all areas of medicine, including pediatrics, internal medicine, cardiology, geriatrics, oncology, neurology, etc. Pathologists are teachers and often provide hospital medical inservice training conferences for doctors and other healthcare professionals. Many organize and direct monthly multidisciplinary "Tumor Board" meetings with oncologists, surgeons and family doctors and help develop patient specific therapy plans.

In general, the earlier a disease is detected and treated, the greater the chance of a cure and the more cost-effective the treatment. Pathology plays a particularly important role in preventive medicine by ruling out diseases or detecting them early. For example, by reporting a high cholesterol level found with a blood test, the pathologist can help the patient's physician control the condition and prevent a heart attack or stroke. Thirty years ago, physicians had relatively few laboratory tests to use to detect disease.

With advances in biomedical science, over 2,000 tests on blood and body fluids are now available. Medical technologists and other laboratory personnel work with pathologists to insure that these tests are available to physicians when and where they are needed, and that the results are accurate. Some tests, such as a glucose test, produce results that are understood by all physicians. Others require specialized professional interpretation by an expert, usually a pathologist.

All tissues removed at biopsy or surgery are examined grossly and microscopically by a pathologist who confirms a diagnosis so that correct therapy can be initiated.

With the help of cytotechnologists, pathologists also examine cells taken in a Pap smear or through fine needle aspiration (FNA), to detect abnormal cells that might signal cancer. FNA allows physicians to remove fluid and cells from a suspected tumor using a hollow needle and may take the place of surgery to obtain a biopsy. Traditional microscopic examination is now complemented by a sophisticated array of high tech electronic and molecular biologic techniques.

In microbiology, microorganisms-bacteria, viruses, fungi, and parasites-which can cause infections are identified and the most effective drugs to treat a particular infection can be determined. In clinical chemistry, many hundreds of tests are available which measure the amounts of materials such as glucose and cholesterol in the blood, urine, spinal fluid, or other body fluids. In immunology, tests that measure the body's response to infection or disease are performed. Many infections, including hepatitis and AIDS, are diagnosed by detecting the antibodies that the patient's immune system makes to fight the infection. In diseases such as arthritis and multiple sclerosis, the body actually makes antibodies against itself.

A popular misconception is that the pathologist's major responsibility is performing autopsies. Although this is one of the pathologist's duties, it certainly isn't the only one. The autopsy is the final quality assurance study that a doctor or a patient's family can request.

All anatomic pathologists are required to be trained in forensic pathology. There are approximately 12,000 board certified pathologists in the U.S. who practice their specialty in community, university, and government hospitals and clinics, in independent laboratories, or in private offices, clinics, and other health care facilities. Some pathologists devote their careers to research in pathology, developing new tests and new instruments to better diagnose diseases.